155. Pregnancy Symptoms Explained - With Real Solutions That Work

Nausea at 6 AM and again at 6 PM. Dizziness when you stand up. Breathlessness climbing the stairs. Fatigue so deep it surprises you. Constipation that nothing seems to fix. These experiences are common in pregnancy — but common does not mean you have to just live with them.

In this episode of Cycle Wisdom, Dr. Monica Minjeur breaks down the five most common pregnancy symptoms, explains exactly why each one happens, and shares evidence-based options that actually help — including a fascinating 2023 discovery about a hormone produced by the fetus that may explain why some women suffer so much more than others when it comes to nausea. Through Sophie's story, a first-time mom at 10 weeks who was struggling to get through her days, you will see how understanding what is happening in your body changes everything about how you manage it.

You will learn:

• What GDF15 is — the newly discovered fetal hormone that is now understood to be the primary driver of pregnancy nausea — and why your family history predicts your experience
• The evidence-based interventions for nausea, dizziness, fatigue, shortness of breath, and constipation that are safe in pregnancy and rarely offered proactively
• When common pregnancy symptoms warrant urgent evaluation — and when they are simply your body doing something remarkable

If you are pregnant and suffering through symptoms nobody has explained — this episode will change how you navigate your pregnancy. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 2 0:00

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Speaker 0:34

Pregnancy can come with a list of symptoms that nobody fully prepares you for. Nausea at 6:00 AM, and maybe again at 6:00 PM. Dizziness when you stand up, breathlessness while trying to climb the stairs, and constipation that nothing seems to fix. These experiences are common, but common doesn't mean you have to just live with it. Today, we're talking about what's actually happening in your body during pregnancy, including a remarkable recent discovery about why some women suffer so much more than others, especially when it comes to nausea. We also discuss some evidence-based options that exist to help you feel better quickly I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their wellbeing through personalized healthcare grounded in clinical excellence. So let's get started, as always, with a patient story, and we'll call her Sophie. Now, Sophie came to us about 10 weeks pregnant with her first baby. She had previously been really healthy and active, but was struggling significantly with many different symptoms that she hadn't anticipated. While she was grateful and excited to be pregnant, she was also incredibly overwhelmed, and she felt like she was having a hard time getting through her day. The fatigue was next level. She had nausea that was in the morning and in the evening, and all of these symptoms made it difficult for her to continue with her daily activities. She called us after a couple of days of being unable to keep down any food and after she had vomited up some of her prenatal vitamins the night before. She wanted to understand what was happening and what she could actually do to move herself in the right direction. We discussed all of Sophie's symptoms. She had nausea. This had a peak in the morning as well as evening time, and this is a classic pattern we find. It's oftentimes worsened when you have an empty stomach and can be improved by some different, simple over-the-counter remedies, which we'll talk about a little bit later. Sophie was also struggling from dizziness, specifically when she changed positions, and this blood volume expansion can cause significant problems with throwing off her fluid intake as well as sodium intake, especially since she wasn't keeping things down. So we addressed that and discussed small changes she could make to improve the dizziness. She was also unfortunately suffering from some constipation, and we talked about ways to help improve this that would also help to improve the nausea and get the gut moving again. With specific interventions for each symptom she was experiencing and an understanding of why each was happening, Sophie felt significantly better within two weeks. Now, her symptoms didn't disappear completely, but they became much more manageable, and she felt like she had more tools in her toolbox in order to be able to address these symptoms when they did show up Now, there are many symptoms that can be common in pregnancy, and we're gonna talk about the most common today. Now, these five symptoms we're gonna talk through are nausea, dizziness, fatigue or excessive tiredness, shortness of breath, and constipation. Now, these are the most common pregnancy complaints, and up to 85% of pregnant women will experience at least one of these, if not multiples, most commonly nausea and vomiting, especially in the first trimester. Now, the physiology or the reason behind each of these symptoms is distinct, and understanding each of those pieces can change how you approach the symptomatic relief. Most women unfortunately receive very minimal guidance on what to actually do about these symptoms. They're told, "Well, this is just normal. Deal with it and wait it out." But there are safe, evidence-based options that exist for each of these symptoms that are simply not routinely offered. We're going to break each of these symptoms down one at a time and talk through what are the different things you can do today to help improve your pregnancy symptoms. Before we break down each of these symptoms, I want to address a couple of myths that we oftentimes will hear. The first is that many people will say, "Well, morning sickness only happens in the morning. Why am I sick all day?" Nausea in pregnancy has a couple of different drivers and can peak at any time of the day or, in some women, can be constant throughout the day. Another myth we oftentimes hear is women are told, "Well, you'll just have to push through the symptoms and figure it out." However, there is meaningful evidence that certain specific interventions can make significant changes in your overall quality of life during pregnancy. And finally, the most common one that we hear is that any time I have shortness of breath or dizziness, there must be something wrong with my lungs or my heart, and I need to go to the emergency room. Now, we're gonna discuss a little bit today about how to discern when do I need urgent evaluation versus what is normal, and that will hopefully help you to understand which pieces are manageable and which require additional expert evaluation. So let's start off with the most common pregnancy symptom, which is nausea and vomiting. Now, we're gonna start though with something that I find fascinating, and this was a more recent discovery just back in 2023, so only a couple years ago. Researchers found a hormone called growth and differentiation factor 15, otherwise known as GDF15. This hormone is produced by the fetus and the placenta, and it rises rapidly in early pregnancy and triggers the brainstem to have more nausea and vomiting. For many years, women were told this is just a normal part of pregnancy, or the more sick you are, the better it is for your pregnancy. And the reality is that this GDF15 that we have found, this hormone, is actually the primary driving factor that induces nausea and vomiting in many, many women. The severity of your nausea is determined by two factors. The first is how much GDF15 the baby is actually producing, and the second is how sensitive the mother is to it. Women who have lower levels of GDF15 before pregnancy are much more sensitive to the surge when the fetus begins to produce GDF14. We have this huge swing of low levels of GDF15 rising to those higher levels when the baby starts producing it and significantly increasing the severity of symptoms. There is a particular genetic condition called beta thalassemia, and these women naturally have higher levels of GDF15 throughout their entire lifetime, so they are basically desensitized to it. When they get pregnant, their GDF15 levels do increase, but because they've had higher levels consistently, these women have significantly lower rates of nausea and vomiting in pregnancy. That lifelong exposure they've had to the GDF15 significantly desensitizes them, and many of them have little to no issues with nausea or vomiting at all. So the next step that researchers are now taking is they're exploring whether pre-pregnancy exposure to GDF15 might desensitize women before conception. And this could be a potential treatment strategy or prevention strategy for things like nausea and vomiting or the more severe form, also called hyperemesis gravidarum. Family history does play a role here. If your mom or your sister had significant or severe pregnancy nausea, your GDF15 sensitivity may be similar. This is a biological pattern. This is not something that you can fight. So we still don't know all of the implications or how we fix this, but finding this actual hormone that is significantly related to the severity of your symptoms is groundbreaking and a huge, huge step in the right direction of being able to hopefully find some treatment strategies moving forward In the meantime, until we get GDF15 figured out better and how we minimize the significant swing, there are other things that also contribute to nausea and vomiting and some things that can make a difference. So HCG, or human chorionic gonadotropin, is the primary hormone that baby and the placenta secrete as it is growing. So the higher the level of HCG typically will correlate with more severe nausea, which is why that when women are pregnant with twins or more, they oftentimes will have worse symptoms. Those HCG levels increase significantly more if you're pregnant with twins. Now, some women, even with single pregnancies, even with normal HCG levels, still will have significant implications of nausea and vomiting, and this is where we believe that GDF15 may be playing a bigger role. So until we figure out what can be done with GDF15, how do we minimize the significant shifts, what can you do in the meantime? Now, there's lots of different things you can try that are out there, but the things I'm going to present for treatments today all focused on things that have practical use and have evidence-based research that supports these findings. So the first one we talk about with nausea and vomiting is ginger. Multiple randomized control trials confirm that it is effective to take ginger at up to 1,000 milligrams per day to help with decreasing nausea and vomiting. Another strategy we utilize often is vitamin B6. This is also called pyridoxine, and you can use vitamin B6 in dosages of 10 to 25 milligrams three times a day. This was an endorsed first-line therapy by the American College of Obstetrics and Gynecology. Another important piece to remember is to try and never let your stomach become completely empty. If your stomach is completely empty, we have more acidity that typically fires. This can cause heartburn and trigger nausea and vomiting. So we recommend focusing on small, frequent protein-containing snacks to help keep your blood sugar stable and to reduce those nausea triggers. For some patients, I will explain to them, even before you get out of bed in the morning, pop a cracker, pop in a ginger chew, something to help so you have something in your stomach before you even sit up. And finally, avoiding anything that is a potential trigger. Strong smells, spicy or higher fat foods, laying down right after eating, all of these can sometimes cause more problems in individuals. So if you notice that these are triggering to you, try and avoid them wherever possible. Next pregnancy symptom we're gonna talk about is dizziness. Now, blood volume increases by about 40 to 50% during pregnancy. This means that if you have all of your blood volume, you're going to increase about 50% of that during pregnancy as you are growing and building a placenta, as the uterus grows, and as that baby grows. This is one of the most dramatic physiological adaptations that happens during our entire life. Typically, other changes that happen are much more slow and less dramatic, but this significant volume expansion of your blood is significant, and in many women, those early changes can lead to problems with dizziness because we're unable to keep the dilation of our blood vessels when it comes to that volume expansion. So for many women, when they stand up especially, blood pressure drops and dizziness occurs, and this is most common in the first and second trimesters as your body is generating all of this new blood. So practical steps for this one, not necessarily quite as straightforward as supplements, but one of the things we always will talk with our patients about is increasing your fluid intake and increasing your salt intake. Modest salt intake helps support that fluid retention and blood volume, and making sure you have enough fluids helps with that blood volume so that your blood pressure doesn't drop out. Something else that can really help is slow position changes, especially when you go from lying down to sitting up or from sitting to standing. I generally will tell individuals if they're struggling with dizziness, go ahead and sit up at the edge of the bed for maybe 5 or 10 seconds first. Make sure that your head seems clear, you're not feeling lightheaded. Stand up next to the bed. Wait another 10 or 20 seconds before you head off to the races. Oftentimes, these slower position changes give your body enough time to have a few heartbeats to pump more blood all the way up to your brain to prevent that dizziness in the first place. And then finally, later on in your pregnancy, especially second and third trimester, avoiding any swelling in your legs can also be a significant way to improve dizziness. Oftentimes, this is going to mean wearing compression stockings, keeping your legs elevated, but basically trying not to let all of that extra blood just pool in your legs. Continuing to get that circulation going and getting that blood supply up to the brain helps with dizziness in the long run. All right, let's talk a little bit about fatigue. Now, fatigue is another very common symptom that we hear, and many women especially are troubled by fatigue during the first trimester. They say, "It doesn't look like much is going on. My body doesn't look all of that different. Why am I so incredibly exhausted?" Fatigue, especially during the first trimester, is oftentimes driven primarily by progesterone. Now, progesterone is a natural sedative at high levels, and for most women, their progesterone levels generally top out no higher than about 30 nanograms per milliliter prior to pregnancy. However, during the course of your pregnancy, progesterone levels typically will get up into the 200 plus range, and this significant shift in the progesterone can add to fatigue. There is an enormous demand on your body as well during first trimester of developing the placenta and a dramatic increase in metabolic rate. So your body is growing a placenta, expanding blood volume, upre- regulating other major systems in your body, and growing a baby. And so energy expenditure is significant, even if you don't seem to be doing much. Another thing that can compound this fatigue is if you have iron depletion. So if you don't have enough iron stores in order to help support this growing blood volume, it can significantly worsen your fatigue. This is why we oftentimes will recommend checking your ferritin or your iron store levels alongside blood counts from early on in pregnancy. If it's found to be low, we want to ensure that your prenatal vitamin contains adequate iron, and we generally recommend ferrous bisglycinate. This generally causes less problems with constipation and tends to be a little bit more gentle on your stomach. Now, many prenatal vitamins do have this particular form of iron in it, and so don't cause as much troubles. But again, important to check and see, do I have a good prenatal vitamin that's not going to add to constipation if iron is a problem? The others that things that can help are getting those regular meals. Protein at every meal to stabilize your blood sugar, support your energy can really be impactful, as well as light movement, walking or prenatal yoga, or other exercises that are more restful rather than just expending extra energy. And finally, and most importantly probably from a standpoint of managing fatigue, is just getting more rest. It is not unusual to require two or more hours of additional rest or napping throughout the day. Please do not feel guilty about resting. Your body is doing incredibly important things. You are growing a human being. You are growing your blood supply, and this is a significant way that you can address this. Let your body rest when it needs to rest. This is not the time to go crazy, start a new routine, start planning all the baby room stuff. Please get some rest Another common symptom we hear is shortness of breath. Now, there's two main mechanisms that play a role with this, and it depends upon how far along you are as to which one is playing more of a role. So early on in pregnancy, progesterone actually stimulates the respiratory center in your brain to increase your breathing rate and the depth of breathing. So you're breathing more, and you're breathing more oftenly, and you're breathing deeper even before the uterus makes any changes. This is physiological. This does not cause any problems, but this is your body's way of having additional energy of helping to increase that blood supply. During the second and third trimester, the uterus itself expands, pushes up on your diaphragm, and it can actually move the diaphragm by up to four centimeters, which is pretty significant. This increased upwards pressure on the diaphragm can reduce your lung capacity and can make it more problematic to be short of breath, especially with exertion. Oxygen demand also increases by about 15 to 20% in pregnancy to support the growing fetus and the placenta. So if you are experiencing any problems with shortness of breath, first of all, start with slowing down your pace. It is normal to be short of breath with exertion during pregnancy, and the recommendation is to just modify your activity rather than stopping entirely. Focusing on your posture can also be helpful. Sitting up straight, standing tall gives the diaphragm more room, whereas slouching over or keeping huddled up can kind of compound that problems with shortness of breath. Additionally, this applies to when you're sleeping. Many women find that they do better if they're sleeping a little bit more propped up, again, to reduce that diaphragm compression. Laying on your left side also can be helpful to make sure we get blood supply to the lungs where it needs to be. Now, I wanna be really clear that there are some distinct times when shortness of breath is not just normal and physiologic. So if you are short of breath at rest, if you're having chest pains, if your heart is racing or you're having palpitations, or if you're having significant swelling in your legs or in your face, these all warrant immediate assessment to rule out something more serious, like an underlying lung or heart condition, and some of these things can manifest during pregnancy. So yes, take shortness of breath seriously, pay attention to it, but watch for those warning signs as well. And finally, constipation. Now, constipation can be really problematic even from early pregnancy, and again, multiple mechanisms playing a role here. So again, the progesterone that our bodies are producing in order to support that placenta relaxes smooth muscle throughout the body, including the intestinal walls. And so everything in our gut slows down significantly in pregnancy as we have that significant upward shift of the progesterone. Again, as I mentioned previously, sometimes the iron supplements, which are common in prenatal vitamins, can be a significant contributor to constipation in many women. Now, I'm a strong proponent of not cutting out your iron supplement or switching to a gummy, but rather to perhaps switch to a prenatal vitamin that has a better form of iron in it. Something like having the iron bisglycinate typically tends to be more gentle, better absorbed, and causes less problems with the constipation Another target is to aim for getting at least 25 to 30 grams of fiber per day, ideally from whole food sources. Now, you can add in a fiber supplement, but it's really hard to get to that entire 25 to 30 grams of fiber daily, so we recommend adding in things like fruits, vegetables, beans, and whole grains. Now, I do always recommend increasing your fiber intake gradually. The average American diet has only about 8 to 10 grams of fiber daily, so if you jump straight to 25 to 30 grams, you will likely have some gastrointestinal distress. So start slow, work your way up from there. It's also important with that fiber that we make sure we're getting enough water. We need to have enough water to keep things fluid enough that it can continue moving through your system. And then if you need to utilize something else over the counter, you can add in something like magnesium citrate. There are multiple different versions of this, and they are typically very gentle, pregnancy safe options that will soften the stool without being a laxative and without making things go too far the other direction. Gentle movement as well as walking, gentle yoga, stretching, doing that on a daily basis also can improve your gut motility, especially as the uterus grows. So when you get into second and third trimester, as the baby is compressing the colon, being able to move and keep things active typically will also help to keep things moving along in the right direction. So let's wrap it up with just a couple of common questions we get. First one: I had terrible nausea in my last pregnancy or my last two or three pregnancies. Does that mean it's gonna happen again? Unfortunately, the answer is likely yes. Based on the research that we have from that GDF 15, growth and differentiation factor 15, oftentimes we'll say yes, there does tend to be a genetic link to it. If you've experienced severe nausea in the past, or especially if you've experienced hyperemesis gravidarum, where you have significant severe nausea and vomiting, we recommend to start preventative measures early, from the first sign of a pregnancy test. So get used to having small frequent meals, start some vitamin B6 if possible, start some ginger. Ideally, try and focus on those preventative strategies before your symptoms get to be problematic and discuss this with your doctor at your first appointment. There are other supplements and other prescription strength medications that are considered safe, and so it may be worth considering some of those if that is appropriate for you What happens if my nausea is so severe that I can't keep anything down? I am throwing up my vitamins. I am throwing up water. When do I have to worry? There is a condition called hyperemesis gravidarum, and it is severe, persistent vomiting with the inability to keep down food or fluids. This oftentimes can lead to weight loss. So if you lose more than 5% of your body weight, or if you have signs of dehydration, I am not urinating, my mouth is dry, all of these would warrant prompt medical evaluation and treatment in an emergency room setting typically if your OB isn't able to take care of you and see you rapidly. We oftentimes end up needing to provide IV fluids, hydration, and sometimes IV medications to help with this nausea. So please don't just blow it off and say, "This is the way it is," or, "Hey, I must have really terrible GDF15." No, this is a significant medical condition that does require urgent evaluation. Imagine if every pregnant woman was given not just a list of symptoms to expect, but a clear explanation of why each one is happening, including the knowledge that your nausea may have a genetic basis that is finally being understood by science. Imagine if this is normal was always followed by, and here is what helps, so that women could spend less of their pregnancy suffering and more of it understanding and working with their bodies. Pregnancy care can be comprehensive and compassionate from the very first appointment. Paying attention to the full physiological experience, not just outcomes measured on a monitor or through lab work, this is what it looks like to care for the whole woman. This is part of how we improve health and promote wellness throughout your entire pregnancy and beyond

Speaker 3 25:05

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